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Abstract Background Hospitals usually encounter human, capital, and financial resource constraints which alerts the efficient use of allocated resources more than ever. Health system managers are required to identify inefficient hospitals and the drivers of the inefficiencies. Although there are multiple studies examining the efficiency of public hospitals in East Africa, their findings are often variable and inconsistent. Therefore, this study aimed to review published articles on technical efficiency of public hospitals in East African countries. Methods A systematic search of published articles on the technical efficiency of public hospitals was employed using Pubmed, Cochrane library, and google scholar and thirteen studies were included to this review. The studies were described in terms of their publication year, sample size, inputs and outputs used in the efficiency analysis, and the technical efficiency levels. Finally, we assessed their quality and estimate the mean technical efficiency using meta-analysis. Results The technical efficiency score of public hospitals varied across countries in east Africa which ranged from 0.64 ± 0.34 in Tanzania to 0.99 ± 0.03 in Ethiopia. The mean technical efficiency was 0.82 (95% CI = 0.56, 1.07) for primary hospitals and 0.88 (95% CI = 0.82, 0.95) for secondary level hospitals. Technical efficiency of public hospitals was negatively correlated with the number of hospitals (the sample size) and positively correlated with the number of inputs and outputs included in the efficiency analysis. Conclusions This review revealed that the technical efficiency of public hospitals in east Africa requires an improvement. To enable effective and efficient hospital management and improvement in hospital efficiency, health managers and policymakers must identify the drivers of hospital inefficiency. Systematic reviews on public hospital efficiency, which are currently rare in Africa, should be conducted on a much larger scale in order to create more, and validated information for use in policy-making. Trial registration This review protocol was registered and approved by the international prospective register of systematic reviews with a Protocol ID: CRD42023444729.

Abstract Introduction The emergence of First-line Antiretroviral Therapy (ART) regimens fails; it necessitates the use of more costly and less tolerable second-line medications. Therefore, it is crucial to identify and address factors that increase the likelihood of first-line ART regimen failure in children. Although numerous primary studies have examined the incidence of first-line ART failure among HIV-infected children in Ethiopia, national-level data on the onset and predictors remain inconsistent. Hence, this study was conducted to fill the gaps in determining the onset of first-line ART failure and its predictors among HIV-infected children in Ethiopia. Methods Articles related to our topic of interest were searched using a systematic approach in national and international electronic databases. The retrospective follow-up cohort studies published in English up to 2022 were included. The data were extracted using a Microsoft Excel spread sheet and exported into Stata™ Version 17.0 for further management and analysis. The level of heterogeneity was quantified using I2 test together with a 95% confidence interval (CI). The incidence of the primary estimates was estimated using a random effects model in the Dersimonian-Lairedmethod. Subgroup analysis, Meta regression, and sensitivity analysis were computed to identify the source of heterogeneity but not explained. The predictors of first-line ART failure were explained using relative risk (RR) with 95% confidence interval (CI). Results Ten studies having a total of 5446 children were included. The pooled onset of first-line ART failure was 3.18 (95% CI: 1.91, 4.44) per 100 child-years of observations. Those study participants who began ART at an advanced WHO clinical stage at ART initiation had a 3.05 (95% CI: 1.47, 6.36), having poor ART adherence had a 2.19 (95% CI: 1.29, 3.70), and having TB-HIV coinfection at ART initiation had a 1.43 (95% CI: 1.06, 1.94) times higher chance of experiencing first-line ART failure than their corresponding counterparts. Conclusion The onset of first-line ART failure was high to achieve the 2030 UNAIDS target of ending the AIDS epidemic. Advanced WHO clinical stage, poor first-line ART adherence, and having TB-HIV coinfection were identified predictors. Hence, community HIV screening should continue to strengthen early ART initiation, and the attention of ART adherence should be kept to achieve ending the AIDS epidemic. The baseline tests and diagnosis, like TB diagnosis should be maintained for HIV-infected children while they begin ART.

Introduction: Emergency healthcare services enable early detection and life-saving interventions for time-sensitive acute injuries and illnesses. The aim of this paper was to assess health care professional's perception towards determinants of effective emergency healthcare services in public health centers of Addis Ababa, Ethiopia, in 2023. Methods: A facility-based cross-sectional study was conducted at public health centers in Addis Ababa with a sample of 422 study participants. Study participants were selected using simple random sampling techniques. To identify factors associated with the outcome variable, bi-variable and multi-variable logistic regression analyses were conducted. Variables having a p-value less than 0.05 in multi-variable logistic regression analysis were declared determinants of positive perception towards emergency medical services effectiveness. Results: Among the study participants, 76.3 % (95 % CI: 72.3, 80.6) had a positive perception towards the public health centers effectiveness in providing emergency healthcare services. Moreover, training (AOR: 4.05; 95 % CI: 1.97, 8.32), ICT service implementation (AOR: 6.55; 95 % CI: 3.37, 12.73), resource availability in the emergency department (AOR: 5.07; 95 % CI: 2.51, 10.25), and management support (AOR: 3.22; 95 % CI: 1.66, 6.25) were determinant factors associated with the perception of effectiveness in emergency medical care services. Conclusion: Nearly three-fourths of healthcare providers in Addis Ababa perceived that the emergency healthcare services were effective. Furthermore, training on patient service delivery, ICT service implementation, availability of resources in emergency departments, and management support were independent determinants of positive perception towards effective emergency healthcare services.

BackgroundDevelopmental delay is a group of disorders that cause common deficits of adaptive and intellectual function in children. It happens when a child fails to achieve one aspect of developmental skills. Limited information is available regarding the prevalence of developmental delay among children aged 12–59 months in the study area. Therefore, this study aimed to assess the prevalence of developmental delay and its associated factors among this population.MethodsA community-based cross-sectional study was conducted in Dembecha district among 702 children aged 12–59 months. Data were gathered through face-to-face interviews, and by taking anthropometric measurements using a pretested structured questionnaire. Data were entered into Epi Data version 4.2 software and exported into Statistical Package for Social Science (SPSS) version 25 software for analysis. The WHO Anthro software was used to analyze anthropometric-related data. Bivariable and multivariable binary logistic regression analyses were done to identify factors associated with developmental delay. The odds ratio with a 95% Confidence Interval (CI) was estimated to determine the strength of the association.ResultsThe prevalence of developmental delay among children was 26.7% (95% CI: 23.5, 30.2). Toddler child age (AOR = 2.60; 95% CI: 1.42, 4.87), low birth weight (LBW; AOR =4.90; 95% CI: 2.14, 11.48), cesarean section mode of delivery (AOR = 8.60; 95% CI: 3.93, 18.65), preterm delivery (AOR = 2.5; 95% CI: 1.28, 4.74), early initiation of complementary feeding (AOR = 8.40; 95% CI: 3.61, 19.63), stunting (AOR = 2.90; 95% CI: 1.67, 5.22) inadequate meal frequency (AOR = 3.20; 95% CI: 1.74, 5.94), and inadequate dietary diversity (AOR = 3.10; 95% CI: 1.68, 5.85) were significantly associated with child developmental delay.ConclusionThe prevalence of developmental delay among children was high in Dembecha district compared to the global prevalence. Child developmental delay was associated with toddler child age, LBW, cesarean section mode of delivery, preterm delivery, initiation of complementary feeding before 6 months, stunting, inadequate meal frequency, and inadequate dietary diversity. Therefore, preventing preterm delivery and LBW, initiating complementary feeding before 6 months, stunting, and achieving the minimum meal frequency, and minimum dietary diversity are recommended to prevent child developmental delay.

IntroductionThe most common and severe cause of morbidity and mortality among HIV- positive children is opportunistic infections (OIs). All HIV-infected children are at risk of developing a variety of OIs. Healthcare workers, programmers, and other stakeholders are in doubt about using the onset and predictors of OIs among schoolchildren on antiretroviral therapy (ART) due to the presence of conflicting results found in the primary studies. Hence, this study was conducted to provide a single figure of onset and specific predictors of OIs by overcoming the existing heterogeneity in Ethiopia.MethodsThe included studies were searched from different national and international databases systematically. The included studies were cohort in design and published in English between 2015 and 2022. The data were extracted using a validated Microsoft Excel tool after the quality of the included studies was assured. The extracted data were exported to Stata Version 17.0 for further management and analysis. The presence of heterogeneity across studies was checked using the Chi-square test and quantified using the I2 test. Various methods, including forest plots, publication bias assessment, sensitivity tests, subgroup analysis, and meta-regression, were employed to determine the source of heterogeneity, but none were successful. The overall onset of OIs was estimated by pooling the incidence of primary studies using a random-effects meta-analysis model. The predictors were identified using meta-regression and the presence of significant association was declared using a p-value of 0.05 with 95% CI. The strength of association was reported using an adjusted hazard ratio with 95% CI.ResultsEleven studies were included in this systematic review and meta-analysis. The onset of OIs among schoolchildren on ART in Ethiopia was 5.58 (95% CI: 4.50, 6.67) per 100 children-years of OI-free observations. Those children who had no parents had a 1.41 (95% CI: 1.10, 1.80) times higher chance of getting OIs when compared with those children having one or both parents. Children who had poor ART adherence had a 2.96 (95% CI: 1.66, 5.29) times higher chance of experiencing OIs than children who had good ART adherence. Finally, the chance of experiencing OIs among rural children was 2.15 (95% CI: 1.63, 2.83) times higher than their counterparts in Ethiopia.ConclusionsThree in every 33 schoolchildren on ART developed OIs in Ethiopia. Predictors of OIs included schoolchildren without parents, those with poor adherence to ART, and rural residents. This suggests that social support, medication adherence, and access to healthcare services may play important roles in preventing and controlling OIs among schoolchildren living with HIV in rural areas.

IntroductionSevere acute malnutrition (SAM) is a critical public health concern in Ethiopia, contributing to high morbidity and mortality rates among children. Despite the improvement in hospital coverage and the development of standardized WHO treatment guidelines, recent reviews indicated a wide range in recovery rates (34%–88%) due to several context-specific factors. Understanding the factors influencing the recovery time can help inform targeted interventions and improve the overall management of SAM cases. Therefore, this study aimed to assess the time to recovery and predictors of children aged 6–59 months with severe acute malnutrition in Addis Ababa, Ethiopia, in 2023.MethodsAn institutional-based retrospective follow-up study was conducted among children aged 6–59 months who were admitted to Tirunesh Beijing Hospital (TBH), Addis Ababa, Ethiopia, from July 2019 to June 2023. The Kaplan–Meir estimate and survival curve were used to compare the time to recovery using a log-rank test among different characteristics. A Cox proportional hazard regression analysis model was used to identify significant predictors of time to recovery. Finally, a p-value of

Abstract Background Emergency laparatomy is abdominal surgery associated with a high rate of mortality. There are few reports on rates and predictors of postoperative mortality, whereas disease related or time specific studies are limited. Understanding the rate and predictors of mortality in the first 30 days (perioperative period) is important for evidence based decision and counseling of patients. This study aimed to estimate the perioperative mortality rate and its predictors after emergency laparatomy at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia, 2023. Methods This was a Hospital-based retrospective follow-up study conducted at Debre Markos Comprehensive Specialized Hospital in Ethiopia among patients who had undergone emergency laparatomy between January 1, 2019 and December 31, 2022. Sample of 418 emergency laparatomy patients selected with simple random sampling technique were studied. The data were extracted from March 15, 2023 to April 1, 2023 using a data extraction tool, cleaned, and entered into Epi-Data software version 3.1 before being exported to STATA software version 14.1 for analysis. Predictor variables with P value

Abstract Introduction Loss of follow-up (LTFU) from ART regular follow-up is one of the key acknowledged causes for the development of ART-resistant virus strains currently. It becomes a major weakness for the successful implementation of HIV care and treatment programs mainly in Sub-Saharan Africa but also globally. About 20—40% of children on ART loss their regular ART follow-up annually. Because of the inconsistency of the prior publications' findings, policymakers, programmers, and healthcare providers find it difficult to intervene. Hence, this study was conducted to provide a pooled incidence and identify the predictors of LTFU among children on ART in Ethiopia. Methods Articles were searched from PubMed/ MEDLINE, CINAHL, EMBASE, Google Scholar, and Science Direct, as well as organizational records and websites. This review included both retrospective and prospective follow-up studies published in English. The data were extracted using Microsoft Excel and exported into Stata™ Version 17.0 for further processing and analysis. The presence of heterogeneity was assessed using forest plots with the I2 test. To identify the source of heterogeneity subgroup analysis, meta-regression, publication bias, and sensitivity analysis were computed. The pooled incidence of LTFU was estimated using a random effects meta-analysis model with the DerSimonian-laired method. To identify the predictors, a 95% confidence interval with relative risk was used to declare the presence or absence of an association. Results In this systematic review and Meta-analysis, nine studies with a total of 3336 children were included. The pooled incidence of LTFU from ART was 5.83 (95% CI: 3.94, 7.72) per 100 children-years of observation with I2: 83% & p-value

IntroductionTuberculosis is a contagious bacterial disease caused by Mycobacterium tuberculosis. The emergence and spread of drug-resistant strains of M. tuberculosis in both developing and developed countries has made diagnosis, treatment, and control of tuberculosis more difficult. The PCR assay, which is a fast and sensitive technique and an alternative method for detecting multidrug-resistant tuberculosis, is used to determine rifampicin (RIF) resistance. There is no single figure in Ethiopia that represents rifampicin-resistant tuberculosis and that is why this study was conducted to overcome the inconsistency of the results of the previous studies.MethodsStudies were researched from five major electronic databases. Studies which were cross-sectional in design, published, and written in English were included. The data were extracted using Microsoft Excel, and the data were managed and analyzed using Stata™ Version 17.0 statistical software. The Forest plot was used to check the presence of heterogeneity. The publication bias, meta-regression, and subgroup analysis were used to find out the source of heterogeneity. A random effect analysis model was used to pool the prevalence of RR TB from primary studies, and associated factors of RR among TB patients were identified using Meta regression. The presence of association was reported using OR with 95% CI.ResultsThe overall pooled prevalence of tuberculosis was 14.9% (95% CI: 13.34, 16.46), of these approximately 7.48% (95% CI: 6.30, 8.66) showed rifampicin-resistant tuberculosis in Ethiopia. Among the computed variables, 2.05% living with HIV1.39 (95%CI: 1.13, 1.72) and having a history of TB treatment (95%CI: 1.34, 3.15) were identified as significant factors associated with RR TB in Ethiopia.ConclusionDrug-resistant TB is one of the prevalent emerging infectious diseases among TB patients, which affects approximately one out of every thirteen TB patients. Having TB-HIV coinfection and a history of prior TB treatment were identified as significant factors associated with RR TB. To prevent and control RR TB, patients should complete their follow-up course; the health professionals should educate the actions taken by the patients when they experience drug toxicity and side effects; and the Minister of Health should initiate telemedicine and recruit tracers to overcome TB patients’ default and have good drug adherence and retention after initiation of the treatment.

Introduction: Poison is defined as any chemical that has the potential to affect or harm human physiology due to its chemical activity. Poisoning is becoming a major preventable public health issue in many countries, including Ethiopia. There is a variation in acute poisoning mortality among the existing evidence in Ethiopia. This study aims to determine the pooled mortality rate from acute poisoning and its predictors in Ethiopia. Methods: We searched available evidence of acute poisoning mortality in databases such as PubMed, Hinari, Cochrane, ScienceDirect, and other search engines. Using the Microsoft Excel data extraction form, three authors independently extracted all relevant data. The Higgins I2 test statistics were used to examine heterogeneity among included studies A random-effects model was used to analyze the pooled estimates and predictors in Stata MP version 17. Results: We retrieved 2685 relevant records from different database sources, and after screening, 21 studies (17 published and 4 unpublished) were included. The pooled mortality rate for acute poisoning was 4.69(95 % CI: 3.69, 5.69 I2 = 94.7 %). The most common poisoning agents are organophosphate (29.9 %), household cleansing agents (17.5 %), and pharmaceuticals/medications (9.3 %). The majority of poisoning cases were intentional poisoning committed suicide. Poisoning cases in rural areas [RR: 3.98(95 % CI: 1.41, 11.25)] and delayed arrival times [RR: 2.90(95 % CI: 1.45, 5.84)] were identified predictors of mortality. Conclusions: In this study, the pooled mortality from acute poisoning was 4.69 %. Poisoned cases from rural areas and delayed arrival times to the hospital were predictors of mortality. To prevent mortality, healthcare professionals should give special attention to rural residents and delayed arrival of poison cases. To control this avoidable death, poison control centers should be strengthened, and other preventive measures implemented at the national level.

IntroductionAnxiety and depression are among the common comorbidities of people diagnosed with cancer. However, despite the progress in therapeutic options and outcomes, mental health care and support have lagged behind for cancer patients. Estimating the extent and determinants of mental health disorders among cancer patients is crucial to alert concerned bodies for action. In view of this, we aimed to determine the pooled prevalence and determinants of anxiety and depression among cancer patients in Ethiopia.MethodsRelevant literatures were searched on PubMed, African Journals Online, Hinari, Epistemonikos, Scopus, EMBASE, CINAHL, Cochrane Library, and Gray literature sources. Data were extracted into an Excel spreadsheet and analyzed using STATA 17 statistical software. The random effect model was used to summarize the pooled effect sizes with their respective 95% confidence intervals. The I2 statistics and Egger’s regression test in conjunction with the funnel plot were utilized to evaluate heterogeneity and publication bias among included studies respectively.ResultsA total of 17 studies with 5,592 participants were considered in this review. The pooled prevalence of anxiety and depression among cancer patients in Ethiopia were 45.10% (95% CI: 36.74, 53.45) and 42.96% (95% CI: 34.98, 50.93), respectively. Primary and above education (OR= 0.76, 95% CI: 0.60, 0.97), poor social support (OR= 2.27, 95% CI: 1.29, 3.98), occupational status (OR= 0.59; 95% CI: 0.43, 0.82), advanced cancer stage (OR= 2.19, 95% CI: 1.38, 3.47), comorbid illness (OR= 1.67; 95% CI: 1.09, 2.58) and poor sleep quality (OR= 11.34, 95% CI: 6.47, 19.89) were significantly associated with depression. Whereas, advanced cancer stage (OR= 1.59, 95% CI: 1.15, 2.20) and poor sleep quality (OR= 12.56, 95% CI: 6.4 1, 24.62) were the factors associated with anxiety.ConclusionThis meta-analysis indicated that a substantial proportion of cancer patients suffer from anxiety and depression in Ethiopia. Educational status, occupational status, social support, cancer stage, comorbid illness and sleep quality were significantly associated with depression. Whereas, anxiety was predicted by cancer stage and sleep quality. Thus, the provision of comprehensive mental health support as a constituent of chronic cancer care is crucial to mitigate the impact and occurrence of anxiety and depression among cancer patients. Besides, families and the community should strengthen social support for cancer patients.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42023468621.

IntroductionGrowth monitoring and promotion services are strategies to promote child health and reduce child mortality. Even though Ethiopia is attempting different strategies to cope with the low rate of GMP utilization, the problem is still unresolved.ObjectiveDetermine the pooled proportion of GMP utilization and its contributing factors among children less than two years in Ethiopia.MethodThe review protocol was registered with PROSPERO, number CRD42023472746. The PRISMA-2020 statement guided the conduct of this review. Electronic databases and grey literature were used. Heterogeneity was evaluated using I2. Subgroup analysis was conducted. The random effect model was used to summarize the pooled effect sizes with their respective 95% CI with STATA version 17. To test the small study effect, the funnel plot and Egger's test were applied.ResultA total of seven (7) studies with 4027 participants were considered in this meta-analysis. The pooled proportion of GMP utilization reported by seven studies was 25.71% (95%CI: 24.39, 27.04). ANC follow-up (AOR = 2.11; 95% CI: 1.47, 2.76), PNC follow-up (AOR = 1.96; 95% CI: 1.44, 2.49), counseling (AOR = 2.88; 95% CI: 2.09, 3.68), maternal education (AOR = 2.89; 95% CI: 1.66, 4.13), paternal education (AOR = 3.78; 95% CI: 2.25, 5.32), family health card (AOR = 2.31; 95% CI: 1.67, 2.96), and mothers good knowledge towards GMP (AOR = 2.90; 95% CI: 1.72, 4.07) variables were positively associated with GMP service utilization.Conclusion and recommendationThe pooled proportion of GMP remains low in Ethiopia. ANC and PNC follow-up, counseling, maternal and paternal education, family health cards, maternal knowledge towards GMP were significantly associated. Findings are essential for evidence-based policy making, intervention, and input for ongoing research.

IntroductionThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an extremely rare virus that devastates the economy and claims human lives. Despite countries' urgent and tenacious public health responses to the COVID-19 pandemic, the disease is killing a large number of people. The results of prior studies have not been used by policymakers and programmers due to the presence of conflicting results. As a result, this study was conducted to fill the knowledge gap and develop a research agenda.ObjectiveThis study aimed to assess the mortality rate and predictors of COVID-19 hospitalized patients in Ethiopia.MethodsElectronic databases were searched to find articles that were conducted using a retrospective cohort study design and published in English up to 2022. The data were extracted using a Microsoft Excel spreadsheet and exported to StataTM version 17.0 for further analysis. The presence of heterogeneity was assessed and presented using a forest plot. The subgroup analysis, meta-regression, and publication bias were computed to identify the source of heterogeneity. The pool COVID-19 mortality rate and its predictors were calculated and identified using the random effects meta-analysis model, respectively. The significant predictors identified were reported using a relative risk ratio and 95% confidence interval (CI).ResultsSeven studies with 31,498 participants were included. The pooled mortality rate of COVID-19 was 9.13 (95% CI: 5.38, 12.88) per 1,000 person-days of mortality-free observation. Those study participants who had chronic kidney disease had 2.29 (95% CI: 1.14, 4.60) times higher chance of experiencing mortality than their corresponding counterparts, diabetics had 2.14 (95% CI: 1.22, 3.76), HIV patients had 2.98 (95% CI: 1.26, 7.03), hypertensive patients had 1.63 (95% CI: 1.43, 1.85), and smoker had 2.35 (95% CI: 1.48, 3.73).ConclusionCOVID-19 mortality rate was high to tackle the epidemic of the disease in Ethiopia. COVID-19 patients with chronic renal disease, diabetes, hypertension, smoking, and HIV were the significant predictors of mortality among COVID-19 patients in Ethiopia. COVID-19 patients with chronic diseases and comorbidities need special attention, close follow-up, and care from all stakeholders.

Abstract The coronavirus disease-2019 (COVID-19) pandemic has posed a significant multifaceted threat to the global community. Ethiopia, as a Sub-Saharan African country, is suffering from chronic food insecurity, and the emergence of such a pandemic will exacerbate the situation. As a result, this study investigated the spatial variation of non-resilience to food insecurity, its relationship with COVID-19, and household coping strategies to become resilient in the long run among households in the East Gojjam Zone of Northwest Ethiopia. From September 22 to December 24, 2020, an agro-ecological-based cross-sectional study of 3532 households was conducted to assess the spatial distribution and associated factors of non-resilience to household food insecurity. The enumeration areas (EAs) and households were chosen using a multistage sampling technique. Data were gathered using a semi-structured questionnaire and checklist using an Android device loaded with an Open Data Kit (ODK) template. Binary logistic regression was used to identify the specific factors associated with household non-resilience to food insecurity. A thematic analysis was conducted to investigate the opportunities and challenges of resilience for household food insecurity. Nearly two-thirds (62.5%) of the households were farmers, 67.9% lived in rural areas, and nearly three-quarters (73.8%) earned less than or equal to ETB 2100 per month. Males headed more than four-fifths of the households (81.7%). We found that nearly two-thirds of the households (60.02%), 95% CI 58.40, 61.64) were food insecure. After bivariate logistic regression, we found that households who were divorced (AOR = 2.54 (1.65, 3.87)), daily laborers (AOR = 2.37 (1.15, 4.87)), government employees (AOR = 2.06 (1.05, 4.05)), residents of highland and hot areas (AOR = 11.5 (5.37, 16.77)) and lowland areas (AOR = 1.35 (1.02, 3.15)) were frustrated by COVID-19 (AOR = 1.23 (1.02, 1.50)) and price inflation (1.89 (AOR = 1.42, 2.56))) were at higher odds of being non-resilient to household food insecurity at a 95% confidence level. Geospatial hot spot analysis revealed that Kurar kebele (the lowest government administrative unit) in Dejen District and Debre Markos town were the red-hotspot areas of household non-resilience to food insecurity. Less than a quarter of the households attempted to cope with food insecurity by adjusting their food consumption, while more than 60% of the households chose none of the coping strategies tested. According to the thematic analysis, the degree of poverty (lack of asset ownership), the COVID-19 pandemic, farm decreased variety, and low crop productivity were identified as challenges to coping with the hardship of resilience to food insecurity. During the COVID-19 pandemic and public emergency, the proportion of households that were unprepared for food insecurity reached its peak. It was recognized that a segment of the population with low economic capacity was more vulnerable to food insecurity and less resilient. Tough developmental gains will be undermined in this case. As a result, each responsible body and stakeholder should develop and implement solid corrective plans for the local context.

IntroductionMarriage between serodiscordant individuals accounts for 65–85% of new infections. Pre-marital Human Immune Virus (HIV) testing opens the door for HIV infection prevention and control. There are no studies that have evaluated the coverage and factors influencing pre-marital HIV testing at the community level in Ethiopia.MethodsThis study was conducted using 10,008 samples of data extracted from Ethiopian demographic and health surveys (EDHS), 2016. To identify individual and community level factors a multi-level binary logistic regression model was used. Among fitted models, “full” model was taken as the best model. To declare the presence or absence of significant association with pre-marital HIV testing, a p-value < 0.05 with confidence interval (CI) was used.ResultsIn Ethiopia, 21.4% (95% CI: 20.6, 22.2%) of study participants had pre-marital HIV testing. Age 35–49 years (AOR = 0.25; 95% CI: 0.09, 0.66), educated (AOR = 1.76; 95% CI: 1.17, 2.79), rich (AOR = 1.95; 95% CI: 1.13, 3.55), having media exposure (AOR = 1.54; 95% CI: 1.30, 4.71), and high community level literacy (AOR = 0.38; 95% CI: 0.22, 0.66) were factors significantly associated with pre-marital HIV testing.ConclusionThe low coverage of pre-marital HIV testing in Ethiopia is insufficient to have a significant influence on the HIV/Acquired Immune Deficiency Syndrome (AIDS) epidemic. Information dissemination to create awareness about human rights and public health implications of pre-marital HIV testing áre necessary while it is made mandatory.

BackgroundBirth asphyxia is the second leading cause of neonatal death in Ethiopia, next to preterm-associated infections. Understanding the causes of death in asphyxiated newborns will help to design appropriate care. This study identifies predictors of neonatal mortality in asphyxiated newborns in selected hospitals in Northwest Ethiopia.MethodsAn institution-based prospective cohort study of 480 newborns with birth asphyxia was conducted at Debre Markos Comprehensive Specialized Hospital, Shegaw Motta District Hospital, and Injibara General Hospital. All newborns with asphyxia admitted to the neonatal critical care unit from the first of November 2018 to the first of November 2019 were included. Data were obtained prospectively from mothers using an interviewer's administered questionnaire. The Kaplan-Meier survival curve was used to estimate survival time, and Log rank test was used to compare the survival curves. Bivariable and multivariable Cox proportional hazards models were fitted to identify the independent predictors of mortality in asphyxiated newborns. Adjusted hazard Ratios (AHRs) with 95% Cis (Confidence Intervals) were used to measure the strength of association and test statistical significance.ResultsThe overall cumulative incidence of mortality among asphyxiated newborns was 42.29% (95% CI: 38%, 46). Asphyxiated neonates with other comorbidities (sepsis, neonatal anemia) (AHR = 2.63, 95% CI:1.69, 4.10), oxygen saturation of 50-69 (AHR = 4.62, 95% CI:2.55, 8.37), oxygen saturation of 70-89 (AHR = 2.82, 95% CI: 1.80, 4.42), severe Apgar score at one minute (AHR = 1.59, 95% CI:1.12, 2.25), neonates with Hypoxic Ischemic Encephalopathy (HIE) (AHR = 6.12, 95% CI:2.23, 16.75) were at higher risk of mortality.ConclusionsThe mortality rate among asphyxiated neonates remains high, and slightly higher than previous studies. Asphyxiated newborns with other comorbidities, severe Apgar score at one minute, who develop HIE, and low oxygen saturation were at higher risk of death. Therefore, designing appropriate interventions and prevention methods should be considered for identified variables.

BackgroundUndernutrition is a frequent and serious problem in the world's older adults. Even though life expectancy is increasing, they are more vulnerable and at risk for nutritional problems. However, not much is known about the nutritional status of this group of the population, and they are often neglected.ObjectiveThis study was aimed at assessing undernutrition and associated factors among older adults in Womberma District, West Gojjam Zone, Amhara Region, Ethiopia, 2020.MethodsA community-based cross-sectional study design was used among randomly selected 594 older adults aged above 60 years with a multistage simple random sampling method and proportional sample size allocation was used to address study subjects at the village level. The collected data was entered into Epi-Data version 4.2 and analyzed by using SPSS version 25. All variables with a p-valueResultsThe prevalence of undernutrition among older adults was found to be 14.6% (95%CI: 11.9-17.7). A number of independent variables have a significant association with undernutrition, including gender, females [(AOR (95%CI): 3.14 (1.50-6.54)], age (Oldest Old [AOR (95%CI): 4.91 (2.44-6.08)] and Middle Old, [AOR (95%CI): 2.96 (1.44-6.08)], meal frequency [AOR (95%CI): 2.01 (1.12 (1.04-3.63)], dietary diversity score [AOR (95%CI): 2.92 (1.54-5.53)], depression [AOR (95%CI): 5.22 (3-9.07)], individuals with a sickness in the last 4 weeks [AOR (95%CI): 2.12 (1.02-4.41)] and individuals with a known hemorrhoid [AOR (95%CI): 3.51 (1.12-10.97)].ConclusionThis study found that the prevalence of undernutrition in older adults is high and needs attention. Sex, age, meal frequency, dietary diversity, being sick in the last 4 weeks, having hemorrhoids, and depression were the associated risk factors. Therefore, the government, family members, and other stakeholders should give more attention to older individuals.

BackgroundTinea capitis accounts for25 to 30% of all fungal infections, but it is often ignored because it is not life threatening in nature. It is more common among schoolchildren particularly in developing countries. Due to the presence of significant variability among the previous studies, this study was conducted to provide a pooled prevalence and associated factors of tinea capitis in Ethiopian schoolchildren.MethodWe conducted a systematic search in five major databases for articles similar to our topic. This review included school-based cross-sectional studies that were reported in English and conducted from 2006 through 2022. The data were extracted using Microsoft Excel and further analysis was done using StataTM Version 17.0 statistical software. Forest plots were used to assess the presence of heterogeneity with 95% confidence intervals. A random effects meta- analysis model was used to pool primary estimates. To declare the presence or absence of association, 95% confidence interval with odds ratio was used.ResultsFourteen studies with a total of 9465 schoolchildren were included. The pooled prevalence was 29.03% (95%CI: 15.37-42.71). There was observed heterogeneity, which could be explained by publication bias (P = 0.04). Family history of tinea capitis (OR: 9.18, 95%CI: 3.5-24.02), under the age of 10 years (OR: 1.65, 95%CI: 1.17-2.33) were factors increasing the development of tinea capitis among schoolchildren and schoolchildren who had hair wash at least once a week (OR: 0.31, 95%CI: 0.24-0.42) was significantly associated with reduced risk for tinea capitis.ConclusionOne of the most prevalent childhood health condition in Ethiopia is tinea capitis, which affects over one in every four schoolchildren. Schoolchildren who had family history of tinea capitis and under the age of 10 years were the identified risk factors but they had hair wash at least once a week was the protective factor of tinea capitis among schoolchildren. Clinical and public engagement activities are needed to overcome the burden of the disease.

Pre-labor rupture of membranes (PROM) is the rupture of fetal membranes before the onset of labor. PROM is found in 3–15% of all pregnancies and 30–40% of preterm labor worldwide. The most serious complications are neonatal and prenatal mortality, which is higher in Africa, including Ethiopia. Despite a paucity of evidence on the magnitude and factors affecting PROM after 28 weeks of gestation but before the onset of labor (including both term and preterm PROM). Hence, the purpose of this study was to determine the magnitude and identify associated factors of the pre-labor rupture of membranes. An institutional-based cross-sectional study was conducted among 315 pregnant women from April 10, 2019 to June 30, 2019 at Debre Markos Referral Hospital. The samples were chosen using a systematic random sampling method among admitted pregnant women. The data were entered using EpiData entry version 4.2 and cleaned and analyzed using Stata/SE version 14.0. In binary logistic regressions, variables with a p-value

[This corrects the article DOI: 10.1371/journal.pone.0259339.].

Introduction: In Ethiopia; even though utilization of health care services has been improved after the introduction of user fee exemption, little is known about the quality of the services. There are fragmented studies on the output dimension of quality of health care services particularly on clients’ satisfaction. Therefore this study aims to assess overall quality (in terms of clients’ satisfaction) and its disparity among users of selected exempted health care services provided in Ethiopia. Methods: The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline was used to undertake this study. Both published and unpublished articles conducted in Ethiopia on the quality of health care services in terms of clients’ satisfaction dimensions were searched. A total of 750 articles were retrieved through international databases (Scopus, MEDLINE/PubMed, Science Direct, Google Scholar and Cochrane Library) and national digital library repositories (Addis Ababa University’s digital library repository); 703 of which were excluded while only 47 articles were included in the meta-analysis. The search for articles was conducted during the period 03 December 2019 to 28 January 2020. For methodological qualities of the included articles assessment, a modified version of the Newcastle-Ottawa Scale adapted for cross-sectional studies was used. R version 3.6.1 and stata version 14 soft wares were used for analysis. A random-effects model was used to calculate pooled estimates. The I2 tests were used to assess the heterogeneity of the studies. Results: The pooled overall prevalence of included 47 studies revealed that clients’ satisfaction among users of selected exempted health care services in Ethiopia was 70% (95% CI: 64, 74%). In subgroup analysis; the lowest prevalence of clients’ satisfaction was observed among users of obstetrics maternal health care services with the prevalence of 65.04% (95% CI: 57.50, 72.58). Conclusion: This study found that more than one-third of respondents; was not satisfied with exempted health care services. There is slight difference in satisfaction of clients across type of exempted health care services and regions. Policy and decision makers in Ethiopia shall design strategies to optimize quality of health care services besides exemption of its costs.it is also strongly recommend that a special emphasis shall be given to obstetric health care services provision. Moreover, concerned stakeholders’ (ministry of health, etc.) should strengthen compassionate respectful care provision in public health facilities; beside to removing user fees.

Background & Aim: The Glasgow Coma Scale is a helpful instrument for measuring patients’ level of consciousness with neurosurgical disorders. Literature showed a majority of nurses don’t believe the Glasgow Coma Scale assessment is their area of practice. This study aimed to examine the Glasgow Coma Scale assessment practice and associated factors among nurses working in adult intensive care units of federally administered hospitals. Methods & Materials: Institutional-based cross-sectional study was conducted on conventionally selected 126 nurses working in adult intensive care units. Six clinical scenarios were used to assess practice, and those who correctly answered at least four scenario questions out of 6 practical scenario questions for the Glasgow Coma Scale assessment were considered good practice. Data was collected using a self-administered questionnaire. The Chi-square test was applied to examine the variables affecting Glasgow Coma Scale practice. Furthermore, the proportions of categorical variables’ replies were contrasted among the various groups. Result: With a response rate of 96.03%, 121 nurses participated in the study. (53.7%) was males. In this study, the overall good Glasgow Coma Scale assessment practice of intensive care units nurses was 47.1%. Lack of training (77.7%), job overload (73.6%), and insufficient knowledge and skills (61.2 %) are barriers for nurses to assess Glasgow Coma Scale. Conclusion: In this, only nearly half of the participants displayed good practice on the Glasgow Coma Scale. Sex and educational status were both found to be significant factors in nurses’ Glasgow Coma Scale assessment practice.

Abstract Background Despite the rapid expansion of antiretroviral therapy services, ‘loss to follow-up’ is a significant public health concern globally. Loss to follow-up of individuals from ART has a countless negative impact on the treatment outcomes. There is, however, limited information about the incidence and predictors of loss to follow-up in our study area. Thus, this study aimed to determine the incidence rate and predictors of loss to follow-up among adult HIV patients on ART. Methods A retrospective cohort study was undertaken using 484 HIV patients between January 30, 2008, and January 26, 2018, at Debre Markos Referral Hospital. All eligible HIV patients who fulfilled the inclusion criteria were included in this study. Data were entered into Epi-data Version 4.2 and analyzed using STATATM Version 14.0 software. The Nelson-Aalen cumulative hazard estimator was used to estimate the hazard rate of loss to follow-up, and the log-rank test was used to compare the survival curve between different categorical variables. Both bivariable and multivariable Cox-proportional hazard regression models were fitted to identify predictors of LTFU. Results Among a cohort of 484 HIV patients at Debre Markos Referral Hospital, 84 (17.36%) were loss their ART follow-up. The overall incidence rate of loss to follow-up was 3.7 (95% CI 3.0, 5.0) per 100 adult-years. The total LTFU free time of the participants was 2294.8 person-years. In multivariable Cox-regression analysis, WHO stage IV (AHR 2.8; 95% CI 1.2, 6.2), having no cell phone (AHR 1.9; 95% CI 1.1, 3.4), and rural residence (AHR 0.6; 95% CI 0.37, 0.99) were significant predictors of loss to follow-up. Conclusion The incidence of loss to ART follow-up in this study was low. Having no cell phone and WHO clinical stage IV were causative predictors, and rural residence was the only protective factor of loss to follow-up. Therefore, available intervention modalities should be strengthened to mitigate loss to follow-up by addressing the identified risk factors.

Abstract Background Vaccination is one of the most cost-effective means of public health interventions to prevent childhood deaths from infectious diseases. Although several fragmented studies have been conducted concerning full vaccination coverage among children aged 12–23 months in Ethiopia, the pooled estimate has not been determined so far. Therefore, this systematic review and meta-analysis aims to estimate the pooled prevalence of full vaccination coverage among children aged 12–23 months in Ethiopian. Methods To find potentially relevant studies, we systematically searched five major databases (i.e., PubMed/MEDLINE, CINAHL, EMBASE, Google Scholar, and Science Direct). This review included community based cross-sectional studies reported in English language; had good quality, and published from the 1st of January 2000 to the 20th of November 2019. Data were analyzed using Stata™ Version 14.1 software. The pooled estimates with 95% confidence intervals (CIs) were presented using forest plots. Higgins and Egger’s tests were used to assess heterogeneity and publication bias, respectively. Primary estimates were pooled using a random effects meta-analysis model. Results Of the total of 851 identified articles 21 studies involving 12,094 children met the inclusion criteria and were included in this meta-analysis. The included studies sample size ranged from 173 to 923. The lowest proportion of full vaccination coverage was reported from Afar Region [21% (95% CI: 18, 24%)], whereas the highest proportion of full vaccination coverage was reported from Amhara Region [73% (95% CI: 67, 79%)]. The overall prevalence of full vaccination coverage among children in Ethiopia was 60% (95% CI: 51, 69%). Conclusions Our finding suggested that six in every 10 children in Ethiopia were fully vaccinated. However, this finding is much lower than the World Health Organization recommended rate. Moreover, high regional variations in terms of full vaccination coverage across the country was observed. Therefore, a special attention should be given to improve the overall childhood vaccination coverage.

BackgroundUrinary tract infection is a major public health problem in developing countries among immunocompromized populations where there are limited health-care services. People living with human immunodeficiency virus (HIV) are more likely to develop urinary tract infections (UTI) due to the suppression of their immunity. There is no single representative figure as well as the presence of significant heterogeneity among studies conducted on people living with HIV in Ethiopia. Hence, this study tried to pool the magnitude of UTI among people living with HIV in Ethiopia.MethodTo find relevant studies, researchers looked through Web of Science, Science Direct, PubMed, EMBASE, the Cochrane Library, Google Scholar, and Worldwide Science. The I2 statistic was used to examine for heterogeneity among the studies that were included. To evaluate the pooled effect size across studies, a random-effects model was used. The presence of publication bias was determined using a funnel plot and Egger's regression test. STATATM version 14.0 software was used for all statistical analyses.ResultsA total of 7 studies with 2257 participants were included in this meta-analysis. UTI was shown to be prevalent in 12.8% (95% CI: 10.8-14.79, I2 = 50.7%) of HIV patients. Being male (0.35, 95% CI:0.14, 1.02), rural residents(OR:1.41,95% CI: 0.85, 2.34), no history of catheterization (OR: 0.35, 95% CI: 0.06, 1.85), had no history of DM (OR:0.84, 95% CI:0.12, 0.597) and having CD4 count greater than 200 (OR:0.36 95% CI: 0.06, 2.35) were the factors which were the associated factors assessed and having association with UTI among people living with HIV but not statistically significant.ConclusionsIn Ethiopia, one in every eight HIV-positive people is at risk of acquiring UTI. Regardless, we looked for a link between sex, residency, CD4, catheterization history, and DM and UTI, but there was none. To avoid this phenomina, every HIV patient should have a UTI examination in every follow-up.

Background: Despite remarkable progress in the reduction of communicable diseases, non-communicable diseases still pose a threat worldwide. One such non-communicable disease is hypertension which remains a major public health problem in Sub-Saharan Africa. Adherence to antihypertensive medication regimens is paramount in reducing its burden. Study findings in Ethiopia regarding adherence to antihypertensive medications and their impact on blood pressure control have been inconclusive and inconsistent. This systematic review and meta-analysis aimed to estimate the pooled adherence to antihypertensive medications and their association with uncontrolled blood pressure among hypertensive patients in Ethiopia. Methods: International databases including PubMed, Web of Science, SCOPUS, CINAHL, PsycINFO, Google Scholar, Science Direct, and the Cochrane Library were systematically searched. All identified observational studies and/or predictors were included, and I2 statistics were used to assess the heterogeneity of the studies. A random-effects model was computed to estimate the pooled adherence level and its association with uncontrolled blood pressure. Results: The random-effect meta-analysis showed that a pooled national antihypertensive medication adherence among hypertensive patients was 65.1% (95% CI: 61.6%, 68.6%). The highest medications adherence was 83.5% (95% CI: 77.0%, 89.9%) occurring in the Somali Region with the lowest medication adherence being 58.5% (95% CI: 47.7%, 69.3%) in the Tigray Region. The meta-analysis suggested a significant increase in medication adherence among patients who had good knowledge of hypertension [POR = 4.26 (95% CI: 4.26 (2.70, 6.72)] and 2.54 times increase in the odds among patients who had co-morbidities [POR = 2.54 (95% CI: 1.06, 6.07)]. This meta-analysis also revealed a 51% reduction of uncontrolled blood pressure among patients who adhered to an antihypertensive medication regimen [POR = 0.49 (95% CI: 0.34, 0.69)]. Conclusions: Two of every three hypertensive patients have adhered to a medication regimen that was associated with reduced odds of uncontrolled blood pressure. Therefore, interventions of highest priority to increase antihypertensive medication adherence are aimed at improving knowledge of hypertension and identifying or screening hypertensive patients who have comorbidities. The Federal Ministry of Health and other relevant stakeholders should increase efforts in the prevention of uncontrolled blood pressure through education on adherence to medication regimens with a focus on modifiable risk factors.

BackgroundAnemia is the reduction of red blood cells in size and numbers and an indicator of both poor nutrition and poor health. It is a major global public health problem. Anemia in adolescents and young adults can have negative effects on their cognitive performance and growth. In Ethiopia, previous studies yielded variable prevalence. This review aimed to determine the pooled prevalence of adolescent girls' anemia and associated factors in Ethiopia.MethodsWe searched for studies reporting anemia and associated factors among adolescent girls as reported in peer reviews publications in Ethiopia from 1988 to 2021 from PubMed, Google Scholar, Web of Science, Science Direct, Cochrane Library, and Worldwide Science database. The search strategy identified 309 cross-sectional studies. After screening for potentially eligible articles, we identified 37 publications for full text review, following which 10 publications were included in the final review. Using data from the review, we performed meta-analysis to produce pooled estimates and assess the prevalence of anemia and associated risk factors. Data were extracted using a standardized data extraction format prepared in Microsoft Excel™ and transferred to Stata ™ Version 14.0 for management and further analysis. To identify the source of heterogeneity, subgroup analysis using sample size and study setup was computed, and I2 test was used to declare the presence or absence of significant heterogeneity during subgroup analysis. A random-effect meta-analysis model was used to estimate the pooled prevalence of adolescent girls' anemia. Moreover associated factors for adolescent anemia were assessed too.ResultsThe overall pooled prevalence of anemia among adolescent girls' in Ethiopia was 23.02% (95% CI: 17.21to 28.84). In the subgroup analysis, studies that have a higher sample size than mean have a higher pooled prevalence (27.35%) (95% CI: 21.42 to 33.28) compared to their counterparts. Age being 15-19 (OR: 2.13; 95% CI: 1.52 to 2.96), living in rural areas (OR: 2.05; 95% CI: 1.66 to 2.54), and low dietary diversity (OR: 1.35; 95% CI: 1.00 to 2.34), were the identified factors associated with anemia among adolescent girls'.ConclusionThe pooled prevalence of anemia among adolescent girls in Ethiopia was moderately high. Being in 15-19 years, rural residence, and low dietary diversity score were found to be the significant factors of anemia among adolescent girls in Ethiopia.

Background. Diabetic retinopathy is the leading cause of blindness among working-aged adults worldwide, including developing countries such as Ethiopia, and the burden of diabetes-related blindness is undeniably posing a massive challenge to the health care system. Diabetes and its micro- and macrovascular complications are becoming more prevalent among Ethiopian diabetics. For that reason, the purpose of this study was to assess the incidence of diabetic retinopathy and its predictors among diabetics in Ethiopia. Methods. A hospital-based retrospective cohort study was conducted using 494 randomly selected diabetics aged above 18 years at Felege Hiwot Comprehensive Specialized Hospital from 2011 through 2014 and was followed until December 2019. The preliminary and longitudinal data was abstracted into demographics, clinical, and physiological attributes using a standardized structured questionnaire. The collected data was entered into the system using EpiData version 4.2 and analyzed using STATA version 14.0. The survival experience of the patients was assessed using the Kaplan-Meier survivor function. The predictors of diabetic retinopathy were identified by the Cox proportional hazard model. Bivariable and multivariable Cox proportional hazard models were computed, and variables having a P value of < 0.05 in the multivariable Cox proportional hazard model were declared as significant predictors of diabetic retinopathy. Results. During the follow-up, the overall incidence rate of diabetic retinopathy was 48 per 1000 person-years (95% CI: 40.0–57.0). Age in years (AHR 1.02; 95% CI: 1.00-1.04), fasting blood sugar level (AHR 1.02; 1.00-1.04), hypertension (AHR 2.61; 95% CI: 1.47-4.63), DM patients who had LDL>100 mg/dl (AHR 2.73; 95% CI: 1.32-5.64), total cholesterol>200 mg/dl (AHR 2.22; 95% CI: 1.08-4.55), and positive proteinuria (AHR 1.74; 95% CI: 1.10 -2.73) were found to be the significant predictors of diabetic retinopathy. Conclusion. The overall incidence rate of diabetic retinopathy was found to be high in both type 1 and type 2 DM. Age, fasting blood sugar levels, hypertension, proteinuria, dyslipidemia, and high systolic blood pressure were all predictors of the development of diabetic retinopathy. Controlling glycemia, dyslipidemia, proteinuria, and blood pressure is critical for halting the progression of diabetic retinopathy.

Background. Continuum care is a basic package approach for women to receive essential services throughout pregnancy, childbirth, and postpartum, and it is critical for women and their infants’ survival and well-being. Although it is an effective strategy for improving maternal and child health, it has not been implemented adequately in less developed countries, primarily in sub-Saharan Africa, including Ethiopia, where 55% of women have been dropped out from the continuum of care. Therefore, this study is aimed at assessing maternity continuum care completion and its associated factors within northwest Ethiopia, 2020. Materials and Methods. A community-based cross-sectional study design was considered among 504 women from March 10 to March 30, 2020, using pretested and structured questionnaires administered via face-to-face interviews. To select study participants, a simple random sampling technique was used. Data were coded, checked, and entered into EpiData software (V. 4.2), then transferred to SPSS (V. 25) for further analysis. A bivariable analysis with 95% CI was performed, and variables with P 0.25 during binary logistic regression were entered into a multivariable analysis to assess predictors’ independent effect. Results. About 177 (37.6%) women completed maternal continuum care. Women with secondary education and above (AOR=2.75, 95% CI 1.42-5.32), urban residence (AOR=2.45, 95% CI 1.35-4.45), using ambulance transport (AOR=3.96, 95% CI 2.19-7.19), mass media exposure (AOR=3.64, 95% CI 2.02-6.56), and distance from health facilities (AOR=3.22, 95% CI 1.84-5.63) showed significant positive associations with completion of maternity continuum care. Conclusion. However, a higher proportion of mothers completed the continuum of maternity care in the district than Ethiopian Demographic and Health Survey 2016 (9.1%); further interventions are compulsory to reach the acceptable level. Hence, comprehensive awareness-raising, education, and promotion activities at the community and health facility levels and empowering women in health care and decision-making backing to expand the completion of maternity continuum of care are necessary.

BackgroundDespite a remarkable progress in the reduction of global rate of maternal mortality, cervical cancer has been identified as the leading cause of maternal morbidity and mortality, particularly in sub-Saharan African countries. The uptake of cervical cancer screening service has been consistently shown to be effective in reducing the incidence rate and mortality from cervical cancer. Despite this, there are limited studies in Ethiopia that were conducted to assess the uptake of cervical cancer screening and its predictors, and these studies showed inconsistent and inconclusive findings. Therefore, this systematic review and meta-analysis was conducted to estimate the pooled cervical cancer screening utilization and its predictors among eligible women in Ethiopia.Methods and findingsDatabases like PubMed, Web of Science, SCOPUS, CINAHL, Psychinfo, Google Scholar, Science Direct, and the Cochrane Library were systematically searched. All observational studies reporting cervical cancer screening utilization and/ or its predictors in Ethiopia were included. Two authors independently extracted all necessary data using a standardized data extraction format. Quality assessment criteria for prevalence studies were adapted from the Newcastle Ottawa quality assessment scale. The Cochrane Q test statistics and I2 test were used to assess the heterogeneity of studies. A random effects model of analysis was used to estimate the pooled prevalence of cervical cancer screening utilization and factors associated with it with the 95% confidence intervals (CIs). From 850 potentially relevant articles, twenty-five studies with a total of 18,067 eligible women were included in this study. The pooled national cervical cancer screening utilization was 14.79% (95% CI: 11.75, 17.83). The highest utilization of cervical cancer screening (18.59%) was observed in Southern Nations Nationalities and Peoples' region (SNNPR), and lowest was in Amhara region (13.62%). The sub-group analysis showed that the pooled cervical cancer screening was highest among HIV positive women (20.71%). This meta-analysis also showed that absence of women's formal education reduces cervical cancer screening utilization by 67% [POR = 0.33, 95% CI: 0.23, 0.46]. Women who had good knowledge towards cervical screening [POR = 3.01, 95%CI: 2.2.6, 4.00], perceived susceptibility to cervical cancer [POR = 4.9, 95% CI: 3.67, 6.54], severity to cervical cancer [POR = 6.57, 95% CI: 3.99, 10.8] and those with a history of sexually transmitted infections (STIs) [POR = 5.39, 95% CI: 1.41, 20.58] were more likely to utilize cervical cancer screening. Additionally, the major barriers of cervical cancer screening utilization were considering oneself as healthy (48.97%) and lack of information on cervical cancer screening (34.34%).ConclusionsThis meta-analysis found that the percentage of cervical cancer screening among eligible women was much lower than the WHO recommendations. Only one in every seven women utilized cervical cancer screening in Ethiopia. There were significant variations in the cervical cancer screening based on geographical regions and characteristics of women. Educational status, knowledge towards cervical cancer screening, perceived susceptibility and severity to cervical cancer and history of STIs significantly increased the uptake of screening practice. Therefore, women empowerment, improving knowledge towards cervical cancer screening, enhancing perceived susceptibility and severity to cancer and identifying previous history of women are essential strategies to improve cervical cancer screening practice.

BackgroundUterine rupture is the leading cause of maternal and perinatal morbidity and it accounts for 36% of the maternal mortality in Ethiopia. The maternal and perinatal outcomes of uterine rupture were inconclusive for the country. Therefore, this systematic review and meta-analysis aimed to estimate the pooled maternal and perinatal mortality and morbidity of uterine rupture and its association with prolonged duration of operation.MethodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used for this systematic review and meta-analysis. We systematically used PubMed, Cochrane Library, and African Journals online databases for searching. The Newcastle- Ottawa quality assessment scale was used for critical appraisal. Egger's test and I2 statistic used to assess the check for publication bias and heterogeneity. The random-effect model was used to estimate the pooled prevalence and odds ratios with 95% confidence interval (CI).ResultsThe pooled maternal mortality and morbidity due to uterine rupture in Ethiopia was 7.75% (95% CI: 4.14, 11.36) and 37.1% (95% CI: 8.44, 65.8), respectively. The highest maternal mortality occurred in Southern region (8.91%) and shock was the commonest maternal morbidity (24.43%) due to uterine rupture. The pooled perinatal death associated with uterine rupture was 86.1% (95% CI: 83.4, 89.9). The highest prevalence of perinatal death was observed in Amhara region (91.36%) and the lowest occurred in Tigray region (78.25%). Prolonged duration of operation was a significant predictor of maternal morbidity (OR = 1.39; 95% CI: 1.06, 1.81).ConclusionsThe percentage of maternal and perinatal deaths due to uterine rupture was high in Ethiopia. Uterine rupture was associated with maternal morbidity and prolonged duration of the operation was found to be associated with maternal morbidities. Therefore, birth preparedness and complication readiness plan, early referral and improving the duration of operation are recommended to improve maternal and perinatal outcomes of uterine rupture.

BackgroundIodine deficiency disorder (IDD) is a global, regional, and national public health problem that is preventable. Universal salt iodization is a worldwide accepted strategy to prevent IDD. The level of iodine in the salt should be adequate at the household level (≥15ppm). Though there was fragmented evidence on the proportion of adequately iodized salt at the household level in Ethiopia, the national level proportion of adequately iodized salt at the household level was remaining unknown. Therefore, this systematic review and meta-analysis estimated the pooled proportion of adequately iodized salt at the household level in Ethiopia from 2013-2020.MethodWe systematically searched the databases: PubMed/MEDLINE, Google Scholar, and Science Direct for studies conducted in Ethiopia on the availability of adequately iodized salt at the household level since 2013. We have included observational studies, which were published between January first, 2013, and 10 August 2020. The report was compiled according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The quality of included studies was scored based on the Newcastle Ottawa quality assessment scale adapted for cross-sectional studies. The data were extracted in Microsoft excel and analyzed using Stata version 14.1 software. We employed a random-effects model to estimate the pooled proportion of adequately iodized salt at the household level in Ethiopia. The presence of statistical heterogeneity within the included studies was evaluated using the I-squared statistic. We used Egger's regression test to identify evidence of publication bias. The pooled proportion with a 95% confidence interval (CI) was presented using tables and forest plots.ResultsWe screened a total of 195 articles. Of these, 28 studies (with 15561 households) were included in the final systematic review and meta-analysis. In Ethiopia, the pooled proportion of adequately iodized salt at the household level was 37% (95% CI: 28, 46%). The subgroup analyses of 28 studies by residence revealed that the pooled proportion of adequately iodized salt at the household level was 32% (95% CI: 29, 35%) and 48% (95% CI: 31, 66%) in rural and urban areas, respectively. Based on geographic location, the highest proportion was found in Addis Ababa (81%; 95%CI: 78, 83), and the lowest proportion found in Dire Dawa (20%; 95%CI: 17, 22). Besides, the proportion of adequately iodized salt at the household level was significantly increased during 2017-2020 (42%; 95% CI: 30, 53%) as compared with 2013-2016 (27%; 95% CI: 17, 39%).ConclusionsIn Ethiopia, the pooled proportion of adequately iodized salt at the household level was very low as compared to the world health organization's recommendation. Thus, the Federal Ministry of Health of Ethiopia and different stakeholders should give more attention to improve the proportion of adequately iodized salt at the household level.

Abstract Background Intimate Partner Violence (IPV) during pregnancy is a serious public health concern globally. Within Sub-Saharan Africa nearly 40% of women reported abuse by their intimate partners. In Ethiopia, study findings regarding prevalence and associated factors of IPV among pregnant women have been inconsistently reported and highly variable. Thus, this systematic review and meta-analysis estimates the pooled prevalence of IPV and associated factors among pregnant women in Ethiopia. Methods International databases (i.e., PubMed, EMBASE, CINAHL, Google Scholar, Science Direct, and the Cochrane Library) were systematically searched during the period of January 1 to February 13, 2018. All identified observational studies reporting the prevalence of IPV and associated factors among pregnant women in Ethiopia were considered. Two authors (AA and CT) independently extracted all necessary data using a standardized data extraction format. Extracted quantitative data were analyzed using STATA Version 13. Heterogeneity among the included studies was assessed through the Cochrane Q test statistics and I 2 test. Finally, a random effects meta-analysis model was computed to estimate the pooled prevalence of IPV. Associations between factors and IPV were also examined using a random effects model. Results After reviewing 605 studies, eight studies involving 2691 pregnant women fulfilled the inclusion criteria and were included in this meta-analysis. The findings of these eight studies revealed that a 26.1% (95% CI: 20, 32.3) overall prevalence of IPV among pregnant women in Ethiopia. The subgroup analysis of this study further revealed the highest observed prevalence was in Oromia region (35%), followed by Amhara region (29%). Mothers‘educational status (OR: 2.1, 95% CI: 1.1, 3.7), intimate partners’ educational status (OR: 3.5, 95%CI: 1.4, 8.5), and intimate partners’ alcohol use (OR: 11.4, 95%CI: 2.3, 56.6) were significantly associated with IPV among pregnant women. Conclusion This study found that the prevalence of IPV among pregnant women in Ethiopia was quite common; with slightly more than 1 in 4, pregnant women experienced IPV during pregnancy. Mothers’ educational status, intimate partners’ educational status, and intimate partners’ alcohol use were factors significantly associated with IPV among pregnant women.

Abstract Background Ethiopia has been experiencing a high prevalence of communicable diseases, which resulted in high morbidity, mortality, and hospital admission rates. One of the highest contributing factors for this is lower level of latrine utilization. There had been significantly varying finding reports with regard to the level of latrine utilization and its association with education level from different pocket studies in the country. Therefore, this systematic review and meta-analysis was aimed to estimate the pooled prevalence of household latrine utilization and its association with education status of household heads, in Ethiopia using available studies. Methods This systematic review and meta-analysis was conducted using available data from the international databases, including PubMed, Google Scholar, Science direct, Cochrane library and unpublished reports. All observational studies reporting the prevalence of latrine utilization in Ethiopia were included. Four authors independently extracted all necessary data using a standardized data extraction format. STATA 13 statistical software was used to analyze the data. The Cochrane Q test statistics and I 2 test were used to assess the heterogeneity between the studies. A random effect model was computed to estimate the pooled level of latrine utilization in Ethiopia. In addition, the association between latrine utilization and the educational level of the users was analyzed. Results After reviewing of 1608 studies, 17 studies were finally included in our meta-analysis. The result of 16 studies revealed that the pooled prevalence of latrine utilization level in Ethiopia was 50.02% (95%CI: 40.23, 59.81%). The highest level (67.4%) of latrine utilization was reported from Southern Nations Nationality and People regional state, followed by Amhara regional state (50.1%). Participants who completed their high school and above education were more likely (OR: 1.79, 95%CI: 1.05, 3.05) to utilize latrine compared to those who did not attend formal education. Conclusion In Ethiopia, only half of the households utilize latrine and the level of utilization has significant association with educational status.

BackgroundCigarettes and their by-products (i.e., smoke; ash) are a complex, dynamic, and reactive mixture of around 5,000 chemicals. Cigarette smoking potentially harms nearly every organ of the human body, causes innumerable diseases, and impacts the health of smokers and those interacting with the smokers. Smoking brings greater health problems in the long-term like increased risk of stroke and brain damage. For students, peer pressure is one of the key factors contributing to cigarette smoking. Therefore, this systematic review and meta-analysis assessed the impact of peer pressure on cigarette smoking among high school and university students in Ethiopia.MethodsAn extensive search of key databases including Cochrane Library, PubMed, Google Scholar, Hinari, Embase and Science Direct was conducted to identify and access articles published on the prevalence of cigarette smoking by high school and university students in Ethiopia. The search period for articles was conducted from 21st September, 2018 to 25th December 25, 2018. All necessary data were extracted using a standardized data extraction checklist. Quality and risk of bias of studies were assessed using standardized tools. Heterogeneity between the included studies was assessed using Cochrane Q-test statistic and I2 test. To estimate the pooled prevalence of cigarette smoking, a random effects model was fitted. The impact of peer pressure on cigarette smoking was determined and was reported in Odds Ratio (OR) with 95% Confidence Interval (CI). Meta-analysis was conducted using Stata software.ResultsFrom 175 searched articles, 19 studies fulfilled the eligibility criteria and were included in this study. The pooled prevalence of cigarette smoking among Ethiopian high school and university students was 15.9% (95% CI: 12.21, 19.63). Slightly higher prevalence of cigarette smoking was noted among university students [17.35% (95% CI: 13.21, 21.49)] as compared to high school students [12.77% (95% CI: 6.72%, 18.82%)]. The current aggregated meta-analysis revealed that peer pressure had a significant influence on cigarette smoking (OR: 2.68 (95% CI: 2.37, 3.03).ConclusionMore than one sixth of the high school and university students in Ethiopia smoke cigarette. Students who had peer pressure from their friends were more likely to smoke cigarette. Therefore, school-based intervention programs are needed to reduce the high prevalence of cigarette smoking among students in Ethiopia.